Antithrombotics &Thrombolytics

Antiplatelet Agent

  • prevention of arterial thrombi

Clopidogrel & Ticlopidine

  • inhibit ADP-dependent aggregation of platelet

Glycoprotein GP IIb/IIIa Receptor Antagonist

  • inhibit diverse agonist,ex: ADP & TXA2

Aspirin

  • inhibit cyclo-oxygenase
  • altering balance between TXA2 (which promote platelet aggregation)& PGI2 (which inhibits platelet aggregation)

Anticoagulant

Injectable

Oral

2. Low Molecular Weight Heparin (LMWH)

3. Fendaparinux

  • Factor xa inhibitor
  • use: various thrombosis associated with orthopedic surgery

1.Unfractionated Heparin (UFH)

4.Argathroban & Lepirudine

  • direct thrombin inhibitors
  • use in pt with heparin induced throbocytopenia & those going under per-cutaneous coronary intervention

Warfarin

  • Vitamin K antagonist
  • Delayed onset
  • Monitoring parameter: PT/INR
  • Adverse effects: haemorrphage, purple toe syndrome
  • use:
    -- prophylaxis & treatment of DVT,Pulmonary embolism
    -- prevention of thrombus formation after val replacement
    -- prevention of treatment of atrial fibrillation with embolization
    -- part of treatment of myocardial infarction

Newer oral anticoagulant

  • replace warfarin in VTE
    & atril fibrillation

Rivaroxaban, apixaban, betrixaban

  • Xa inhibitor

Dabigatran

  • direct thrombin inhibitors

Thrombolytic

/Fibrinolytic

1st generation

2nd & 3rd Generation

-tissue-type plasminogen activator=>produce a fibrin-selective activation of plasminogen
-Ex: Alteplase, Reteplase, Tenecteplase,Anistreplase

Streptokinase

  • AR: hemorrhage, pyrexia, anaphylactic reaction

Urokinase

  • activate both circulating and fibrinogen bound plasminogen